Category: Policy Updates

Big Brother (Soon Will Be) Watching

Buried in the more than 800 pages of the bipartisan legislation (pdf) is language mandating the creation of the innocuously-named “photo tool,” a massive federal database administered by the Department of Homeland Security and containing names, ages, Social Security numbers and photographs of everyone in the country with a driver’s license or other state-issued photo ID.

Employers would be obliged to look up every new hire in the database to verify that they match their photo.

David Kravets from Wired.

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May 17, 2013 | 10 comments | by

Has Obama Changed Course on the War on Drugs? No

This is Richard Posner:

The new (that is, the ostensibly new) strategy gives continued primacy to the “war on drugs,” which best describes the criminal-law and (abroad) paramilitary campaigns against the drug trade. No one thinks these campaigns can eradicate illegal drugs. The realistic-seeming objective is, by increasing expected punishment cost and by taking out of circulation (through imprisonment) those not deterred by the cost, the war on drugs raises the prices of illegal drugs. Yet those prices remain very low. The reason appears to be the very high elasticity of supply of drug dealers. It’s like Karl Marx’s “reserve army of the unemployed”; if there is no dearth of persons willing to be drug dealers at modest wages, the principal effect of law enforcement may be to increase labor turnover, at enormous cost in police and prosecutorial resources and above all in incarceration: half the federal prison population in the United States consists of drug offenders. Some 1.7 million persons who are in prison or jail (state or federal) or on probation or parole (or its federal equivalent, supervised release) are in those situations of confinement or restriction because of drug offenses. No doubt the mere fact that drugs are illegal deters some consumers — but how many relative to the large number of persons who have no interest in consuming mind-altering drugs, legal or illegal?

Gary Becker here.

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May 06, 2013 | 11 comments | by

The Obama Sequester

The Obama administration is doing what all governments are tempted to do when forced to make budget cuts. Instead of cutting out waste, they are cutting popular services so as to inflict maximum pain. The implicit goal: try to convince the public the government needs every penny it has. As far as I can tell, the voters aren’t buying it. That’s the real reason Congress just caved on Air Traffic Control. As The Wall Street Journal editorial page explained:

The FAA’s all-hands furloughs managed to convert a less than 4% FAA budget cut into a 10% air-traffic control cut that would delay 40% of flights. The 6,700 flights that the FAA threatened to force off schedule every day is twice as many delays as the single worst travel day of 2012…

[F]rom the beginning the FAA’s delays were deliberate and avoidable. The FAA has ample legal discretion to protect core services but chose instead to maximize disruption. It is a sign of the FAA’s institutional culture of failure that it can’t even sabotage itself successfully…

The Senate bill clarifies that the FAA has the authority to cut waste and nonessential items before it lays off controllers — which the White House falsely claimed the sequester law prohibited it from doing.

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Apr 29, 2013 | 8 comments | by

Big Brother

What happens if you don’t pay your taxes? People who commit tax fraud can face big fines and even imprisonment. Then there is this:

Depending on where you live, if you shirk on your taxes, you might:

  • have your medical or law license suspended;
  • be denied a hunting or fishing license;
  • have your passport revoked;
  • have your driver’s license suspended, and your renewal of your vehicle registration denied;
  • be deported;
  • be denied housing assistance;
  • be barred from a government contract and government employment;
  • have your liquor license revoked (if you’re a restaurant).

And perhaps most crushingly, you can:

  • be denied the right to operate a concession, ride or booth at Minnesota’s annual state fair.

Joshua Blank study via Catherine Rampell.

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Apr 15, 2013 | 13 comments | by

Where Does Your State Rank?

The State of Health Care Spending, by Andrew Rettenmaier and his colleagues:

The compendium is divided in two main parts. Part 1 summarizes the four ways by which the geography of health care spending is described. Health care spending as a percent of the states’ GDP is the first way in which the geography of health care is presented and is separated between Medicare, Medicaid, and non-Medicare/Medicaid spending. These data allow for analysis that extends back to 1980 for each state. Next, health care spending is analyzed on a per capita basis and is again divided between Medicare and Medicaid per enrollee in the programs, and average non-Medicare/Medicaid spending for the states’ population who are not enrolled in the programs. The second part of the compendium comprises 50 state summaries. The two-page summaries are based on the four ways of viewing geographic variation in health care spending and the health care markets. The first page summarizes the key health care spending indicators in each state, and provides graphical representations of how the state compares to the national average now and in the past. Also depicted is the variation in county level Medicare spending. The second page of each state’s summary presents all of the recent metrics in tabular form. Medicare spending in four large or geographically dispersed counties is also presented at the end of each table. (Summary by Michael Ramlet)

Tom Saving and I discuss some of the results at the Health Affairs blog.

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Apr 09, 2013 | 7 comments | by

The Vision Thing

Ramesh Ponnuru and Yuval Levin proposed a Republican health reform plan in National Review. This led to petty carping by Matt Yglesias, a response by Levin, clarification by Ben Domenech and more petty carping by Ezra Klein.

Here’s the problem. The Republican reformers are talking mechanics and not principles. They propose a list of changes they would like to make, but are unclear on why they would like to make them. Therefore, they open the door to the critics — who are more than happy to divert everyone’s attention away from the huge problems with ObamaCare.

There are two central questions to be asked about any health care system:

  1. What help will people get from government to make insurance affordable?
  2. Will the insurance be portable and, if not, what will be done about the pre-existing condition problem?

Answers below the fold.

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Apr 04, 2013 | 13 comments | by

Shopping without SHOP

The Affordable Care Act stipulates that each state will have a Small Business Health Options Program, or SHOP exchange beginning next year. But now the whole world knows what insiders have known for months. There is no way in the world that the states will be ready. So the Obama Administration has put these off until 2015.

What does that mean? I think it means community rating in the small group market with no exchange, as of the first of next year. But doesn’t that mean no mechanism for risk adjustment and no mechanism for determining what community rating actually means?

Without an exchange, it’s really hard to force a carrier to take all comers. If a group of sick people wants to sign up for my plan, I don’t answer their phone calls. If a group is really healthy, I camp out on their door step.

Without an exchange, every insurer will find hundreds of ways to game the system.

Am I wrong?

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Apr 04, 2013 | 13 comments | by

Bill Frist Wants to Ban FFS

Here we go again. Once an idea gets fixed in certain minds, it never goes away. Politico reports –

The National Commission on Physician Payment Reform is calling for eliminating the fee-for-service model within seven years, starting with a five-year transition period to a blended payment system.

This commission is chaired by Bill Frist, MD, former Senate Majority Leader. He also wrote an op-ed with Steven Schroeder in which he says we can abolish FFS within five years. He writes –

Lawmakers, care providers and insurers must act now to change physician pay incentives to ultimately improve how care is delivered and ensure that the cost of that care is affordable for generations to come. That means moving away from fee-for-service now.

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Mar 27, 2013 | 17 comments | by

HRAs and Defined Contribution − Follow-Up

My last post, “Feds Ban Defined Contribution” generated quite a flurry of comments, both on the list and directly to me. The comments were all from people I respect and admire — and they were split about evenly between people who strongly agreed with my conclusion and people who vehemently disagreed. Wow.

Clearly it is an important topic that needs more attention. Fair warning, though, for those readers who are not into benefits issues — this is not an easy subject and it will not be resolved here. Most likely, if the law survives, it will be like ERISA and endlessly litigated. For a quarter of a century, it seemed that the Supreme Court issued ERISA decisions almost annually, and even then very few people really understood ERISA or how it applied to real life situations.

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Mar 26, 2013 | 30 comments | by

An Idea Whose Time Has Come

Two states, Florida and Georgia, are doing something about our dysfunctional malpractice system. Legislation in Florida would create a no-fault system modeled after the workers’ compensation system. An independent review panel would evaluate claims based on their merits, and an administrative law judge would be on hand to ensure fairness in the process. A similar reform is being proposed in Georgia. (See more details here.) These efforts are based on the NCPA’s proposal to radically reform the way we encourage medical safety. Because the Florida and Georgia proposals continue to focus on the idea of a “medical error,” they don’t go as far as we would like. But it’s a step in the right direction.

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Mar 22, 2013 | 10 comments | by
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